Posted by Elizabeth on August 17, 2001, at 2:54:10
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 15, 2001, at 19:24:14
> Elizabeth - • I believe that a lot of my tirade against Sal is just me refocusing the anger (fear?) that I have been experiencing, lately. I have said my piece (peace?) and will leave Sal alone, from now on (except to correct obvious mistakes, or to add more information). I'm sure he is a nice, compassionate guy, who just wants to help people. Hey, you can't knock a guy for that!
I think he is just trying to help, and his heart is in the right place. But I also think that many of the points you made were legitimate ones and should not be simply written off as misdirected anger (although the manner in which they were *expressed* could be :) ).
> > As I'm sure we all realise, "access" doesn't imply reading and understanding.
> >
> •I am not sure that all of the posters and lurkers would understand the implications.How so? (I'm afraid your explanation here has only served to make me more confused! :) )
> • The Beatles went to India(?) to learn from a yogi about life and beyond when they were heavy into LSD. They thought that taking LSD would be a shortcut to nirvana. They found out it wasn't, especially when the yogi tried to sleep with one of the girls that were brought along. In the same light, just having access to all the medical journals in the world does not make one an expert in the field. I was trying to use an analogy, but I still suck when it comes to writing clearly.
Ahh. I think that analogies often suck anyway. < g > Too often I see poor analogies used in attempts to argue a point that degenerate into irrelevant discussion of the analogy rather than the (only tangentially related) point that was being made. But yours wasn't so bad (I do think analogies certainly have their place in discourse; people just misuse them a lot).
> > I think you're stretching it here. :-)
> >
> • Yeah, I'll give you that one; it was off the top of my head. ;^/< g >
> > > Switching meds is by far not the first step in modifying most medication regimens.
> >
> > I think it depends on the situation.
> >
> • I guess that I should have added, "when a psychotropic medication has shown some efficacy", but as a rule, their are no rules, as you state.But you state it more clearly. :) I tend to agree that if there is a partial response and the side effects are tolerated, augmentation is often preferable to substitution.
> • Subjective experience leads to the objective theory which can be studied using scientific method. I think that you need, as a good base, the objective theory (with it's corresponding studies showing proof), but that base needs to be malleable, so that subjective experience from post-marketing surveillance can be integrated into the theory, when the subjective experience is proven to exist.
Goodness. This is getting intense. My main point was that the RCTs required to get a drug approved and used in the writing of the prescribing information are impoverished when it comes to actual patient experience, which I do think should count for something. People here have often spoken of doctors insisting that their subjective experience on a medication (often, an experience confirmed by other posters!) can't possibly be an effect of the medication, or even that the experience isn't "real!" Your comments and offering of specific examples are helpful.
> The delayed weight gain with Paxil or the increase in non-insulin-dependent diabetes with Clozaril or Zyprexa users are examples of subjective experiences that were pooh-poohed because there was no objective information in the literature.
I think that phenelzine can also contribute to type 2 diabetes, no?
> The posts we answer here are of the subjective nature, where we have to be careful not to read into the case, something that isn't there (hard to do sometimes).
Exactly. And that's one reason why I think that it's important not to generalise personal experience to other people. At the same time, we may discover by reading this board that other people have had similar experiences to our own, which suggests that the experience may be caused by the medication (or whatever) in question.
> > I understand. Your knowledge includes knowledge of your limitations; a person without such knowledge might be unaware of his limitations.
> >
> • I shouldn't take his advice as a personal affront, though.That's reasonable too, but I don't recall your reply to him containing any content that I would expect to be offensive to him or others. So I don't think that the taking-it-personally thing really caused any harm: you made your point, which was a legitimate one, and you've also posted that you realise you were taking Sal's postings as a personal affront.
> I guess the best bet is to monitor his posts.
I guess so, although that's quite a task, as he's a frequent poster.
> He will learn what to say, and not to say, as time goes by.
I hope so.
> • I was alluding to the analogy of the Beatles, where knowledge and insight come only from hard work, and a lot of reading for understanding.
Yeah, I think I get it now.
> • Thanks for your comments, Elizabeth.
And you for yours. (What's with the dots, BTW?)
-elizabeth
poster:Elizabeth
thread:67742
URL: http://www.dr-bob.org/babble/20010814/msgs/75355.html